Balancing between adult harm reduction and youth addiction – the debate goes on

The debate over the approach healthcare providers should take when it comes to suggesting alternative products to help adult patients quit smoking has been ongoing for quite some time. But it’s still controversial. While these products have potential benefits for some patients, there’s also the risk that they could appeal to youth.

In a recent article in Nature, researchers from the Medical University of South Carolina (MUSC), partnered with Brian King, director of the Center for Tobacco Products (CTP) at the US Food and Drug Administration (FDA), stressed the importance for healthcare providers to consider discussing the use of alternatives as tools for adult patients who smoke combustible cigarettes who have been unable to quit by using FDA-approved medications.

The authors pointed out that scientific evidence has always indicated that both products have health risks, but alternatives have lower risks than traditional tobacco products. A Cochrane Review conducted earlier this year has indeed concluded that there is evidence from enough high-quality studies to say that e-cigarettes are more likely to help smokers to quit than nicotine replacement therapy, which includes nicotine gum, lozenges and patches. This stance is in line with that of the FDA.

However, Benjamin Toll, director of the MUSC Health Tobacco Treatment Program, and Tracy Smith, associate professor in the Addiction Sciences Division of the Department of Psychiatry and Behavioral Sciences, said that neither option is good for human health. Nevertheless, among adults who have already tried FDA-approved cessation medications, if the choice is between continuing to smoke traditional cigarettes or switching completely to e-cigarettes, then a complete switch should be encouraged.


A less-harmful source of nicotine than smoking


There are seven FDA-approved smoking-cessation aids, including medication and nicotine replacement options, which, especially when combined with behavioural counselling, improve the chances of quitting smoking. However, due to the addictiveness of nicotine, some people may struggle, and this is one of the reasons why the researchers saw room for alternative tobacco products, which can deliver a source of nicotine that is less harmful than smoking.

Smith said: “Doctors and other healthcare professionals do not know what to say or how to talk about it. I always say, ‘If you have somebody who smokes cigarettes, they are standing in a convenience store every single day, buying the most harmful tobacco product they could be buying.’ And it’s a real injustice not to say to them, ‘Hey, there are nicotine products you could buy every day that would be a whole lot less likely to kill you.’”

However, Toll and Smith are referring specifically to the 23 products that have received FDA marketing authorisation, and all are tobacco-flavoured, not fruity, chocolatey or candy-flavoured.

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    “Some believe that we shouldn’t be allowing new tobacco products on the market that could potentially be appealing to youth, no matter what the benefit is to adults who smoke,” Smith said. “And I am just not in that camp because cigarettes are the primary way that tobacco kills people.”


    Balancing between harm reduction and preventing youth addiction


    The FDA has expressed its commitment to regulating e-cigarettes to ensure they are marketed and sold responsibly, with a particular focus on preventing youth access and addiction, implementing various regulations aimed at restricting the sale and marketing of e-cigarettes to under-age consumers, including flavour bans and age-verification requirements for online sales.

    At the same time, the agency has encouraged e-cigarette manufacturers to submit their products for review through the premarket tobacco product application (PMTA) process, and has issued more than a million denials.

    Overall, while the FDA acknowledges the potential for these alternatives to serve as a harm-reduction tool for adult smokers, its regulatory approach reflects a balancing act between promoting public health and preventing youth initiation and addiction to nicotine.

    Undoubtedly, having less-harmful alternatives out there is important to give adult smokers an option to reduce or quit, but, at the same time, that should be balanced with the concerns around how these products may be appealing to young people – one of the reasons why the debate still continues.

    – Antonia Di Lorenzo ECigIntelligence staff

    Photo: Christian Wiediger

    Antonia Di Lorenzo

    Assistant news editor/senior reporter
    Antonia is a member of the editorial team and holds a masters degree in Law from the University of Naples Federico II, Italy. She moved in 2013 to London, where she completed a postgraduate course at the London School of Journalism. In the UK, she worked as a news reporter for a financial newswire and a magazine before moving to Barcelona in 2019.